“Keeping Students Mental Health Care Out of the E.R.”

A New York Times article focuses on the Department of Education's continuing failure to provide adequate school-based mental health services. Instead of providing such services, schools are dealing with disruptive or troubled students by sending them to emergency rooms. LSNYC-Bronx's Nelson Mar represents the family of the 10-year old profiled in the article.

From the piece:

On Sept. 29, according to a school report, Gabriel told his teacher he
was going to beat up a classmate. While the teacher was trying to calm
him, Gabriel, who was 10 at the time, spotted the boy and pushed him
from behind. The boy whipped Gabriel in the face with a sweater,
scratching him under the eye. Gabriel was enraged, and when the teacher
tried to stop him, he tripped her. Security guards restrained him and
school officials called Emergency Medical Services, which transported
Gabriel to St. Barnabas Hospital’s emergency room, where he was
evaluated by a psychiatrist.

Gabriel did not need to be admitted to the hospital, the psychiatrist
wrote; he was cleared to return to school the next day.

In fact, as few as 3% of students sent to the emergency room are actually admitted to the hospital—a sign that the E.M.S. calls themselves are unnecessary.

A few days after the Sept. 29 incident, the school’s special education
committee decided Gabriel — who has been given a diagnosis of attention
deficit and oppositional defiant disorders — needed regular counseling.

He never got the counseling.

Typically, if disruptive children are going to attend a traditional
public school, they are placed in a classroom with a 12-to-1
student-to-teacher ratio and assigned an aide.

Gabriel got neither. Instead, he was mainstreamed in a class of 25 that
included 10 special education students and 2 teachers. Twice more that
year, school officials called E.M.S. to take him to the hospital — once
in restraints — and both times Gabriel was examined and returned to
school the next day.

Frustrated, Gabriel's mother filed a complaint requesting that Gabriel be assigned the special education services he required. At the hearing, she was told there simply wasn't enough money left in the budget. Eventually, Gabriel did receive the services he needed, and is doing considerably better due to a special education teacher who has taught him to control his anger.

Gabriel has lots of company. For more than a decade, mental health and
Education Department officials have worked to reduce referrals to
E.M.S., which they see as an expensive and traumatizing response to
problems that should be handled at the schools.

“Kids who make verbal and behavioral threats to themselves and other
people very much need and deserve a same-day mental health evaluation,”
said Charles Soulé, a psychologist in pediatric psychiatry at
NewYork-Presbyterian Hospital. “But most New York City school kids don’t
have access at the schools, where it’s better done.”

Dr. Soulé, who is the co-chairman of the New York City School-Based
Mental Health Committee, said there had been some progress. In 1999,
when he started working on this issue, 75 schools had mental health
services. Today, according to the Education Department, 319 of the 1,700
schools have such services.

After news media coverage in 2004 highlighted the problem, the
department appointed a full-time administrator to oversee mental health
care. “The D.O.E. understands the need and is committed to improving,
but the issue is resources,” Dr. Soulé said.

In the last few years, care appears to have deteriorated. Dr. Soulé said
the number of schools with services had fallen by 10 percent. Marge
Feinberg, a department spokeswoman, said cuts were due in part to a
reduction in state financing.

It’s likely that there are thousands of mental health cases referred to
emergency rooms each year. In 2009-10, there were 868 E.M.S. calls for
suicidal ideation alone, according to school officials. That would not
include children like Gabriel who are menacing to others.

Nelson Mar, a lawyer with Legal Services NYC-Bronx who represented
Gabriel’s family, said that at one Bronx hospital, there were 58 E.M.S.
calls from schools during a 10-day period in February. (He declined to
identify the hospital because, he said, he feared the emergency room
doctor who provided the data would face disciplinary action.)

Read the rest of the article at NYTimes.com.